*4.4.4 Self-efficacy and critical reflection*

The practice of self-efficacy and reflection also mentioned reducing stress among medical students. The introduction of the reflective practice for students causes them to become the self-directed learner, and they become responsible for their own learning, which greatly alleviates mental distress [67]. The most frequently used tools for reflection are reflective journals, reflective dialogical exercises, and portfolios [68]. A learner should be involved in reflective practices because it provides them a chance to assess their own learning style. Reflection allows students' knowledge to be actively integrated and thus encourages selfdirected, deep, and continued learning [55]. Problem-based learning (PBL) is known to promote self-efficacy and self-directed learning and hence endorse easy transitions during medical education [67].

### *4.4.5 Vertical curriculum*

Vertical curriculum, which is defined as the assimilation between the basic science and clinical segments of the curriculum [64], is known to reduce mental distress because in that there is the early introduction of clinical medicine and students can relate theory to practice [69]. Early exposure of students to clinical medicines gives them instantaneous opportunities to apply the basic science knowledge to the clinical setting and help them in smooth transition through their educational journey [64].

#### *4.4.6 Longitudinal electives*

Longitudinal electives (e.g., communication skills or coping with stress) and other community-based activities seem promising in reducing stress among students [69]. Stress reduction teaching modules or electives intended to raise selfawareness and self-reflection and hence engage in self-care [26].

#### *4.4.7 Promoting professionalism*

Professionalism in medicine can be described as the collection of values, attitudes, and behavior that a health professional show when they deal with a patient, colleagues, and society [70]. Brazeau et al. [26] observed a positive relationship between medical mental well-being and professionalism [71]. Professionalism is mostly considered as a part of the hidden and informal curriculum [72]. The inclusion of professionalism in the formal curriculum is relatively a newer concept, but it becomes today's requirement [73]. Every medical institute should develop their own institutional specific curriculum for professionalism with faculty and students' help along with a structured teaching and learning methods and assessments [18].
